Key result
Synchronous head-up tilt testing combined with transcranial doppler successfully diagnosed vasovagal syncope in three adults presenting with atypical presyncopal abdominal pain.
Why the study?
Atypical syncope is prone to misdiagnosis, and abdominal pain as a precursor to vasovagal syncope in adults is rarely reported and unfamiliar to clinicians.
Case Report (n=3)
No
Abdominal pain may serve as a rare precursor to vasovagal syncope in adults, which can be effectively diagnosed using synchronous head-up tilt testing and transcranial doppler.
Abdominal pain-triggered syncope may warrant vasovagal evaluation; case reports leave open whether tilt testing with TCD should enter routine practice.
Background Syncope is a common condition that increases the risk of injury and reduces the quality of life; atypical syncope is prone to misdiagnosis. Abdominal pain as a precursor to vasovagal syncope (VVS) in adults is rarely reported and unfamiliar to clinicians. Methods We present three adult patients with VVS and presyncopal abdominal pain diagnosed by synchronous multimodal detection (transcranial doppler (TCD) with head-up tilt (HUT)) and discuss the relevant literature. Results Case 1: A 52-year-old man presented with recurrent decreased consciousness preceded by six months of abdominal pain. Physical examinations were unremarkable. Dynamic electrocardiography, echocardiography, head and neck computed tomography angiography, magnetic resonance imaging (MRI), and video electroencephalogram showed no abnormalities. Case 2: A 57-year-old woman presented with recurrent syncope for 30+ years, accompanied by abdominal pain. Physical examination, electroencephalography, and MRI showed no abnormalities. Echocardiography showed large right-to-left shunts. Case 3: A 30-year-old woman presented with recurrent syncope for 10+ years, with abdominal pain as a precursor. Physical examination, laboratory analysis, head computed tomography, electrocardiography, and echocardiography showed no abnormalities. Syncope secondary to abdominal pain was reproduced during HUT. Further, HUTrevealed vasovagal syncope, and synchronous TCD showed decreased cerebral blood flow; the final diagnosis was VVS in all cases. Conclusions Abdominal pain may be a precursor of VVS in adults, and our findings enrich the clinical phenotypic spectrum of VVS. Prompt recognition of syncopal precursors is important to prevent incidents and assist in treatment decision-making. Abdominal pain in VVS may be a sign of sympathetic overdrive. Synchronous multimodal detection can help in diagnosing VVS and understanding hemodynamic mechanisms.
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Wang et al. (2023) conducted a case report in Vasovagal syncope (n=3). Synchronous head-up tilt test (HUT) combined with transcranial doppler (TCD) was evaluated. Synchronous head-up tilt testing combined with transcranial doppler successfully diagnosed vasovagal syncope in three adults presenting with atypical presyncopal abdominal pain.
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